Provider Demographics
NPI:1477648160
Name:IERARDI, RALPH P (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:P
Last Name:IERARDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CELEBRATION PL STE 302
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5435
Mailing Address - Country:US
Mailing Address - Phone:407-303-4080
Mailing Address - Fax:407-303-4099
Practice Address - Street 1:410 CELEBRATION PL STE 302
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5435
Practice Address - Country:US
Practice Address - Phone:407-303-4080
Practice Address - Fax:407-303-4099
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10008237208600000X, 2086S0129X
NJMA598472086S0129X
FLME1366932086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0965167000OtherAMERIHEALTH/KEYSTONE/IBC
NJ6925804Medicaid
NJCA0000279OtherAMERICHOICE
MDP12341700Medicaid
NJ2083240OtherAETNA
G23505Medicare UPIN
MDP12341700Medicaid
NJ2083240OtherAETNA